综合医院病区分类评价指标体系的初步构建

[目的]构建科学、合理的病区分类指标体系,为综合医院病区分类提供科学依据。[方法]采用Delphi法,组建研究小组,初步拟定评价指标,编制专家咨询问卷,选择30名不同领域的护理专家对病区分类指标进行评价,确定病区分类评价指标。[结果]两轮咨询专家积极程度均高于90%,专家权威系数为0.862;确定的指标体系包括3个一级指标、10个二级指标,235个三级指标,指标的重要性评分均值为4.55～5.00分,变异系数为0.00～0.11,协调系数为0.939。[结论]构建的综合医院病区分类评价指标体系的专家积极程度和权威程度较高,指标协调性良好,可为病区分类实践提供依据。     

基于德尔菲专家咨询法构建综合医院病区分类评价指标研究

[目的]构建综合医院病区分类评价指标,为病区分类以及临床护理管理提供参考依据。[方法]成立课题研究小组,制定病区分类评价指标咨询问卷,通过德尔菲专家咨询法对病区分类指标进行评价、赋值,确定病区权重系数,计算各病区综合得分,根据综合得分对病区进行分类。[结果]专家熟悉程度、影响程度、权威程度均值分别为0.84,0.86,0.85;经过两轮专家咨询,确立8项病区分类指标,包括专家评议指标4项(护理技术操作难度、护理风险系数、病人生活自理能力以及病情严重程度)和客观指标4项(平均住院日、一级护理比例、二级护理人数以及危重病人比例);根据8项指标权重系数计算病区权重系数后将38个病区分为11个一类病区、17个二类病区、10个三类病区。[结论]构建的综合医院病区分类指标具有较好的权威程度,可为临床病区分类及临床护理管理实践提供理论基础。     

医院普外科终末护理质量评价指标的研制

【】目的 应用Delphi法初步建立医院普外科终末护理质量评价指标体系,以利于提高专科护理质量和护理管理水平。方法 在回顾大量文献和相关管理标准后初步确立指标,采用Delphi法对上海的10家三甲医院30名护理专家进行两轮专家咨询。结果 两轮函询专家权威系数分别为0.86和0.89;根据专家的意见对指标进行修改。最后形成5个一级指标和18个二级指标的终末护理质量评价体系。结论 得出一套医院普外科终末护理质量评价指标体系,有助于客观、科学地进行普外科终末护理质量的评价和分析,为专科护理质量评价的进一步研究提供参考依据。     

护理硕士专业学位研究生专业能力评价指标体系的初步构建

目的构建护理硕士专业学位研究生专业能力评价指标体系。方法采用专家会议法和专家函询法(Delphi法)对指标体系进行拟定、筛选和修改。结果通过访谈和专家会议法拟定专家函询问卷进行两轮专家函询,专家积性系数为93.94%和93.55%;专家权威系数为0.947,专家两轮文字建议分别为48条和4条,一二级指标重要性赋值均数3.5,变异系数0.25。最终确定的指标体系包括7个一级指标,50个二级指标。结论初步构建护理硕士专业学位研究生专业能力评价指标体系,能够为护理硕士专业学位培养的过程性评价以及终结性评价提供参考依据。     

构建护理服务质量关键指标评价体系的研究

目的构建护理服务质量关键指标评价体系,为规范化的护理服务质量评价提供参考依据。方法采用文献回顾和结构式专家访谈初步确定评价指标框架,应用Delphi法进行两轮专家函询,结合重要性赋值及层次分析法确定各级指标权重,并对函询结果进行统计分析。结果第1轮和第2轮函询的专家权威系数分别为0.748、0.756;专家积极系数分别为100.00%、92.11%,专家协调程度分别为0.365和0.463(P<0.01),专家意见集中程度较高,最终形成了包含结构、过程、结果的3项一级指标、6项二级指标、25项三级指标的护理质量关键指标评价体系。结论基于Delphi法构建的护理服务质量评价体系意见集中,可信度高,可作为临床护理服务质量的评价工具。     

构建儿科护理质量评价体系的研究

目的构建具有儿科护理专科特性的质量评价指标体系,为规范化的专科护理质量评价提供参考依据。方法采用文献回顾和结构式专家访谈初步确定评价指标框架,应用Delphi法进行两轮专家函询,结合重要性赋值及层次分析法确定各级指标权重,并对函询结果进行统计分析。结果第1轮和第2轮函询的专家权威系数平均值分别为0.89、0.87;专家积极系数分别为86.70%、96.15%,专家协调程度分别为0.316和0.378(P0.01),专家意见集中程度较高,最终形成了包含结构、过程、结果的3项一级指标、11项二级指标、34项三级指标的儿科护理质量评价体系。结论基于Delphi法构建的儿科护理质量评价体系意见集中,可信度高,可有效促进临床护理质量持续改进。     

病区分类研究中基于Delphi法建立护理操作共性项目与权重的研究

[目的]应用Delphi法建立医院病区分类的评价指标之一——护理操作共性项目与权重。[方法]提取我院医院信息管理系统(HIS)中所有可计费的护理操作项目106项,由20名专家通过4轮问卷调查进行增删,确立护理操作共性项目内容及各项目权重。[结果]共确定45项共性操作项目及其权重,其中专家的积极性系数平均为97.4%,权威系数平均为0.83,协调系数平均为0.63。[结论]咨询专家代表性强,积极性高,权威程度与协调性好;应用Delphi法建立45项护理操作共性项目与权重,从而计算各病区的共性护理操作项目工作量当量,作为进行病区分类评价的重要指标之一。     

养老护理员岗位胜任力评价指标体系的构建

目的构建养老护理员岗位胜任力评价指标体系,为开展养老护理员选拔、培训和评价提供参考。方法通过查阅文献、半结构式访谈的方法,初步拟定养老护理员岗位胜任力评价指标体系;运用Delphi专家函询法对25名专家进行两轮函询,对各级指标进行筛选、修改和完善,并运用层次分析法和专家重要性赋值平均分配法确定各指标权重。结果两轮函询问卷有效回收率均为100%;专家权威系数为0.91;最终确立的养老护理员岗位胜任力评价指标体系包含4个一级指标、11个二级指标、42个三级指标。结论所构建的养老护理员岗位胜任力评价指标体系具有一定的科学性和实用性。     

运用Delphi法构建新生儿专科护士能力评价指标体系

目的建立新生儿专科护士能力评价指标体系,对新生儿专科护士的任用培训和评价考核提供客观依据。方法采用Delphi法对19名专家进行两轮问卷咨询,第1轮专家咨询对指标进行修订,第2轮咨询在第1轮的基础上增加各指标权重的评判。结果第1、2轮专家咨询的权威系数分别为0.881和0.918,协调系数分别为0.257和0.320,说明专家对各级指标的意见集中且协调程度好;构建的能力评价指标体系包括6个一级指标、16个二级指标和62个三级指标。结论新生儿专科护士能力评价指标体系具有较高的科学性,对新生儿专科护士的任用培训和评价考核提供了客观的参考依据。     

病区分类研究中基于Delphi法建立护理操作共性项目与权重的研究

[目的]应用Delphi法建立医院病区分类的评价指标之一——护理操作共性项目与权重。[方法]提取我院医院信息管理系统（HIS）中所有可计费的护理操作项目106项,由20名专家通过4轮问卷调查进行增删,确立护理操作共性项目内容及各项目权重。[结果]共确定45项共性操作项目及其权重,其中专家的积极性系数平均为97．4％,权威系数平均为0．83,协调系数平均为0．63。[结论]咨询专家代表性强,积极性高,权威程度与协调性好;应用Delphi法建立45项护理操作共性项I／1与权重,从而计算各病区的共性护理操作项目工作量当量,作为进行病区分类评价的重要指标之一。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.